©2018 Forest Health Services. All rights reserved. Unauthorized duplication or modification is prohibited.

April 2018

on TRACK wiTh BARIXSupport to Keep You On Track With a Healthful Lifestyle

There are bound to be some changes to your bowel pattern after weight loss surgery. With a smaller intake

of foods and fluids, which may move more quickly or more slowly through your digestive system, you’ll have to find a new normal for your body. Although you may have periods of constipation or diarrhea, you shouldn’t accept that as normal. Making a few alterations in your diet can help you become regular.

As with any medical condition, consult with your doctor before beginning any treatment.

ConstipationBoth the frequency and size of bowel movements may decrease after sur-gery—this is normal. Difficulty empty-ing the bowels, often combined with abdominal discomfort, or having fewer than 3 bowel movements a week indi-cates constipation.

Why is constipation common right after weight loss surgery?Many factors work together for smooth digestion and elimination. Your body goes through many changes right after surgery, creating a situation where constipation is more likely. Here are a few factors that impact your ability to be regular.

• Anesthesia stops the contractions in your intestine that keeps things mov-ing along. It may take a day or two for those contractions to start back up.

Be Regular

monitor your fluid intake so you know if you’re shorting yourself or not—you’re shooting for at least 64 oz of any type of fluid a day.

• A cup of hot water with lemon, no-added-sugar hot cocoa, decaf coffee (caffeine is fine once you’re drinking 64 oz of fluid a day), or herbal tea may help stimulate your system.

• Try a probiotic. A good one to start with is Nature’s Bounty Advanced or Ultra Strength Probiotic 10.

• Slowly increase the amount of fiber in your diet.

• Eat beans—think black beans, chickpeas, pinto beans, navy beans, kidney beans and white beans. Just ¼ cup provides 4 grams of fiber and 4 grams of protein (mash or blend for the pureed stage).

• Add 1 Tbsp of flaxseed to your yo-gurt or smoothie for 3.3 grams of fiber.

• Mix together ¼ cup applesauce with 1 Tbsp of wheat bran (look in the baking aisle), and 2 Tbsp prune juice—really, it works.

RESTART YOUR SYSTEM FOLLOWING SURGERY

• Pain medications slow the transit through the digestive system and can reduce the urge to go.

• Fluid intake is typically decreased after surgery, resulting in a smaller, harder stool that is more difficult to pass.

• Food volume is limited after surgery and with the focus on protein; fewer fiber-rich foods are consumed, re-sulting in a smaller stool.

• Activity is typically limited, slowing the movement through your diges-tive system.

• Iron supplements, if needed, com-monly constipate. Calcium supple-ments can cause constipation in some individuals.

What can you do?It seems that the odds are stacked against your bowels in the beginning. Here’s what you can do to get things back to normal as soon as possible:

• Drink as much fluid as you are able. Remember to sip slowly all through-out the day. Keep a drink with you at all times. Try different tempera-tures to see what goes down easiest for you. Sometimes popsicles, fud-gesicles and slushies work well. You can let them melt in your mouth. You may be able to drink more room tem-perature or warm liquids. Be sure to

Continued on page 2

©2018 Forest Health Services. All rights reserved. Unauthorized duplication or modification is prohibited.

Page 2Continued from page 1

• Starting with the soft food stage, you can add in cooked veggies and soft canned fruits (packed in water or juice—not syrup). Once on regu-lar foods, fresh veggies should be right behind high-protein foods on your priority list—then add in a little fresh fruit and whole grain.

• Add veggies and fruits to your pro-tein smoothies.

• Add small amounts of healthy fat to your diet. The initial diet is almost fat-free. You don’t want to overdo it, but small amounts of fat may help. Think:

• Avocado—mash it for the pureed stage.

• Coconut oil—add a teaspoon to your protein smoothie.

• Olive oil—use when preparing foods.

• Peanut butter and other nut but-ters.

• Position yourself properly. Place your feet on a small footstool in front of the toilet so your body is in a squat-ting position instead of in a seated position. This position aligns your body for an easier go. If you’d like to purchase a stool designed just for this purpose, look for the Squatty Potty.

• Don’t put it off. If you feel the need to go, give yourself adequate time in a private location so you don’t feel rushed or embarrassed.

• Walk, walk, and then walk some more. Short frequent walks often work best right after surgery, but you’ll want to build your endurance and increase the amount of time you can walk at one time.

• Unless otherwise instructed, wait to take iron and calcium supplements until 6 weeks post-op.

If all else fails and you need a little extra help:

After 3 days without a bowel movement, take:

• 2 Senokot and 2 Colace tablets at

bedtime. This should produce a bow-el movement the following morning.

• If not and if there is no bowel move-ment in the next 3 days, take 2 Seno-kot and 2 Colace tablets in the morn-ing and also at bedtime. You can add 1 ounce of Milk of Magnesia at bed-time.

• Consider a Dulcolax or glycerin sup-pository, or fleets enema after 5-6 days without a bowel movement.

Be sure to contact your surgeon’s office if you are not successful with these ef-forts. You do not want to take laxatives on a regular basis; your body will come to depend on them. Other things to con-sider:

• Many patients swear by a cup of Smooth Move tea in the evening.

• Avoid adding fiber supplements in the first 4 weeks after surgery unless you are able to consistently drink 64 ounces of fluid. Taking fiber supple-ments without adequate fluid can result in greater constipation, not less. Be sure to slowly add in fiber.

Diarrhea Your post-bariatric-surgery body may tolerate foods and beverages very dif-ferently than before. If diarrhea is severe or lasts more than two days, contact your surgeon’s office. Dehydration can develop quickly.

What causes diarrhea and what can you do about it? • Lactose, the sugar found in milk

and to a lesser degree in other dairy products, is a common cause of di-arrhea after weight loss surgery. If you suspect lactose intolerance, avoid dairy for 3 days. If your symp-toms (gas, bloating, and/or diarrhea) resolve, lactose may be the cause. Slowly add dairy products with a low-er lactose content back into your diet (yogurt, cottage cheese, cheese, and some protein drinks) and switch to lactose-free milk.

• High-fat foods can rapidly move down your digestive system, not al-lowing time for fluids to be reab-

sorbed. If the stool is light in color, floats on the top of the water, and looks oily—look at the fat content of the foods you are eating.

• Added sugars can cause dumping syndrome, mostly for those who had gastric bypass surgery. The symp-toms of dumping syndrome can vary, but basically, you feel like you have the flu. You may be light-headed, dizzy, very tired, nauseated, weak, have muscle aches, and may or may not have diarrhea. Keep your intake of added sugars to 2 grams or fewer per serving to prevent dumping syn-drome.

• Sugar alcohols are used to sweeten no-added-sugar or sugar-free prod-ucts. Sugar alcohols don’t impact your blood sugar or insulin levels like added sugars do. They are lower in calories and don’t cause tooth de-cay. The only downside is that if you consume too much, they can cause gas, bloating and diarrhea. Individual tolerance varies, but most people can tolerate about 7 grams of sugar al-cohol per day without the downside. Sugar alcohol is listed separately on the Nutrition Facts label. You can also find them in the ingredient list: maltitol, hydrogenated starch hydro-lysates, isomalt, lactitol, mannitol, sorbitol, xylitol, and erythritol. Eryth-ritol is the exception and typically does not cause gastric side effects even if consumed in large amounts. It tastes good and works well in baked products. You can purchase it online in granulated and powdered form.

• Drastic changes in dietary fiber can lead to either constipation or diar-rhea. Gradually make changes to your intake of fiber-rich foods or fiber supplements.

Probiotics may help. You may want to consider a probiotic supplement to help increase the num-ber of “good” bacteria in your large in-testine. This can reduce diarrhea and constipation. Look for a product with 2 billion or more live cultures. Yogurt and

Continued on page 3

©2018 Forest Health Services. All rights reserved. Unauthorized duplication or modification is prohibited.

Page 3

Reconstructive SURGERY

To receive a free Reconstructive Surgery Guide , call 800-282-0066 or send us an email at rc@barixclinics.com with your name and contact information. Our reconstructive surgery program is currently performed at our centers in Michigan, and Pennsylvania. Call us today for more information!

SUBSCRIBE On Track With Barix

www.barixclinicsstore.com/ newsletter_sign_up.html

Tell us about how your life has changed as a result of your weight loss surgery. Your story may be printed in this publication or on one of our websites and can serve as an inspiration to others.

Submit your story online www.barixclinicsstore.com/share_your_story.html.

We’d love to hear from you!

QUESTIONS ABOUT FINANCING

YOUR SURGERY?Call a Barix Patient

Service Representative 800-282-0066

Share Your SUCCESS

Get Rewarded! This month, you could earn a SPECIAL GIFT for your “It Worked For Me” tips or recipes! Just submit as many recipes and “It Worked For Me” tips as you like. The most original and creative will be awarded a special gift from our online store. Include your name and contact info with your entry — make sure your recipes follow Barix nutritional guidelines. Tips must be submitted by April 30, 2018. Please send comments, ideas, recipes and “It Worked For Me” tips to Deb Hart, RD, LD at dhart@foresthealth.com.

No Bake Protein Bars1-15oz can chickpeas, drained and

rinsed6 large Medjool dates¼ cup creamy almond butter½ tsp vanilla extract½ tsp cinnamon¼ tsp salt3 scoops vanilla protein powder

(Matrix used for nutrition info)2 tbsp hemp seeds2 tbsp chia seeds

Spray a loaf pan with cooking spray and then line wax paper.

Combine chickpeas, dates, almond butter, vanilla, cinnamon, and salt in a large food processor and mix until smooth. Add protein powder, hemp seeds, and chia seeds. Process again until very well combined.

Using wet hands, press mixture evenly into lined loaf pan. Freeze for 60 minutes; slice into 8 bars. Place cut bars in a sealed container in the refrigerator or freezer to store. Let warm to room temperature to eat. Makes 8 servings.

NUTRITION INFORMATION PER SERVING: 210 calories, 15 grams protein, 9 grams fat, 24 grams carbohydrate, 287 mg sodium, 5 grams fiber.

Seedy PB Toast1 slice Aunt Millie’s 35 Calorie Whole

Wheat Bread

1 tbsp. Simply Jif peanut butter

1 tsp ground flax seeds

1 tsp chia seeds

Toast bread. Spread with peanut butter. Sprinkle with seeds and enjoy. Makes 1 serving.

NUTRITIONAL INFORMATION PER SERVING: 198 calories, 8 grams protein, 10 grams fat, 15 grams carbohydrate, 152 mg sodium, 6 grams fiber.

Recipes

kefir are good sources of dietary probiot-ics as well.

If you need some extra help: It’s important to stop diarrhea before it leads to dehydration. Sometimes a medication will be needed to do that. You don’t want to rely on medications, which treat the symptoms, long-term, but make changes to your diet that will eliminate the cause of diarrhea. Imodi-um is a good medication to start with.

Check with your surgeon’s office for al-ternatives if this is not effective. Note that Pepto-Bismol, a common anti-diar-rhea medication contains an aspirin-like compound and should not be taken after weight loss surgery. Stay in contact with your surgeon’s office.Diarrhea or constipation can signal other non-food related issues. Keep in contact with your primary care physician and sur-geon’s office if you are not able to achieve regularity on your own.